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Dental Sealant Policy Update (IB 24-14)

Date: 05/15/24

Louisiana Healthcare Connections is sharing with providers a recent update to the dental coverage for the Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Adult Waiver, and Intermediate Care Facility (ICF) Dental Programs as of May 14, 2024 (IB 24-14).

Effective May 1, 2024, all beneficiaries enrolled in the Early and Periodic Screening, Diagnostic and Treatment (EPSDT), Adult Waiver, and Intermediate Care Facility (ICF) Dental Programs are eligible for one preventive dental sealant application per tooth every 36 months in accordance with Current Dental Terminology (CDT) Code D1351 Dental Sealant – Per Tooth.

Benefit limitations for sealants:

  • Service is reimbursable for tooth numbers 2, 3, 14, 15, 18, 19, 30, and 31. 
  • Teeth must be caries-free on the date of service. Sealants are not reimbursable for teeth that have had previous occlusal restoration. 
  • Sealants must be performed on a single date of service unless restorations or other treatment services are necessary. If restorative or other treatment services are necessary, sealants may be performed on the same date of service as the restorative or other treatment services. If there are circumstances that would not allow sealants to be applied in this manner, the contraindication(s) must be documented in the enrollee's treatment record. 

Claim questions should be directed to the beneficiary’s dental benefit program administrator:

DentaQuest: 1-800-508-6785
MCNA Dental: 1-855-701-6262

For questions related to this bulletin, please contact Andrea Perry at andrea.perry@la.gov.